Waiver & Release
2
North Park - Aug. 4-6 Aug. 11-13 Aug. 7-9 South Park - Boyce Park - Rich Fitzgerald County Executive Basketball Camp Registration Camper Name Address Current Age School Parent/Guardian Name Parent/Guardian Phone Parent/Guardian Email Parent/Guardian Signature & Date Emergency Contact Name Emergency Contact Phone Circle T-Shirt Size: S M L XL Select Camp(s) Attending - Enrollment fee is $40 per child per camp North Park Basketball Courts - August 4-6 Boyce Park Basketball Courts - August 7-9 South Park Basketball Courts - August 11-13 Registration & payment must be made in advance in person by cash, Visa, Master Card, check or money order at the Boyce Park, North Park or South Park offices, or in Room 211 County Office Building, 542 Forbes Avenue, Pittsburgh. Space is limited, so sign up early. Grade (Fall 2014) City State Zip Waiver & Release I the undersigned, being a parent or legal guardian of the child enrolling in the basketball camp, does hereby affirm that the camper named below is in good health and suffers from no illness, disability, injury or condition that requires the taking of medication on a regular basis unless that condition is disclosed and his/her participation has been approved by a physician. Furthermore, the undersigned has no knowledge of any reason the camper named below cannot participate in rigorous physical activity. The undersigned hereby expressly agrees to be responsible for any medical bills incurred in the treatment of any illness, accident or injury. In the event of any such accident or injury, the undersigned hereby consents to allowing any of the camp supervisors or Allegheny County employees to procure any medical treatment they deem appropriate on behalf of the camper named below without prior consent. The undersigned hereby releases the Play Well Allegheny Basketball Camp, its supervisors and coaches, the County of Allegheny, its elected officials, officers, appointees, agents and employees from and against any and all liability arising from injury or illness, mental or physical, sustained or claimed to have been sustained by the camper named below during activity or transportation related to the campers participation in the camp. Camper Health Form Check all that apply: Asthma Concussions Heart Disease Head Injury Convulsions Diabetes Bleeding Disorders Seizures Physical Restrictions (explain) Allergies to Medication Allergies to Food Last Tetanus Immunization (date) Chronic or Recurring Illnesses Operations/Injuries (include date) Medical Insurance Provider Medical Insurance Policy Number
Transcript of Waiver & Release
North Park - Aug. 4-6
Aug. 11-13Aug. 7-9
South Park -Boyce Park -
Rich FitzgeraldCounty Executive
Basketball Camp Registration
Camper Name
Address
Current Age
School
Parent/Guardian Name
Parent/Guardian Phone
Parent/Guardian Email
Parent/Guardian Signature & Date
Emergency Contact Name
Emergency Contact Phone
Circle T-Shirt Size: S M L XLSelect Camp(s) Attending - Enrollment fee is $40 per child per camp
North Park Basketball Courts - August 4-6
Boyce Park Basketball Courts - August 7-9
South Park Basketball Courts - August 11-13Registration & payment must be made in advance in person by cash, Visa, Master Card, check or money order at the Boyce Park, North Park or South Park offices, or in Room 211 County Office Building, 542 Forbes Avenue, Pittsburgh.Space is limited, so sign up early.
Grade (Fall 2014)
City State Zip
Waiver & Release I the undersigned, being a parent or legal guardian of the child enrolling in the basketball camp, does hereby affirm that the camper named below is in good health and suffers from no illness, disability, injury or condition that requires the taking of medication on a regular basis unless that condition is disclosed and his/her participation has been approved by a physician. Furthermore, the undersigned has no knowledge of any reason the camper named below cannot participate in rigorous physical activity. The undersigned hereby expressly agrees to be responsible for any medical bills incurred in the treatment of any illness, accident or injury. In the event of any such accident or injury, the undersigned hereby consents to allowing any of the camp supervisors or Allegheny County employees to procure any medical treatment they deem appropriate on behalf of the camper named below without prior consent. The undersigned hereby releases the Play Well Allegheny Basketball Camp, its supervisors and coaches, the County of Allegheny, its elected officials, officers, appointees, agents and employees from and against any and all liability arising from injury or illness, mental or physical, sustained or claimed to have been sustained by the camper named below during activity or transportation related to the campers participation in the camp.
Camper Health FormCheck all that apply:
AsthmaConcussionsHeart DiseaseHead InjuryConvulsionsDiabetes
Bleeding DisordersSeizuresPhysical Restrictions (explain)
Allergies to Medication
Allergies to Food
Last Tetanus Immunization (date)
Chronic or Recurring Illnesses
Operations/Injuries (include date)
Medical Insurance Provider
Medical Insurance Policy Number
Camp Coaches & Staff•Craig Prosser, Camp Director & Head Coach- AAU Basketball Coach- Former NBA Draft Pick- Former Player at Robert Morris & Canisius College- Robert Morris Sports Hall of Fame Inductee- Canisius College All-Century Team Honorable Mention- Champion Enterprises Basketball Hall of Fame Inductee
•Gavin Prosser- Baldwin High School Girls Varsity Basketball Head Coach- Former Point Park University Assistant Basketball Coach- Former Player at Point Park University- 3-time 1st Team All-Conference selection- NAIA All-American selection- PPU’s 6th all-time leading scorer & 2nd all-time in assists - 2014 Point Park Athletic Hall of Fame inductee
•Renee Brown- Former player at Edinboro University- 2-time PSAC champion (2010-2012)- 2012 PSAC Tournament Most Outstanding Player/MVP- 3-time All-PSAC West selection- 1st team honors junior and senior year- 2nd team honors sophomore year- 2nd team Daktronics-All Atlantic Region senior year- PSAC West Freshmen of the Year 2008-09- 2 NCAA Atlantic Region berths
•Carly Corcoran- Point Park University Women’s Basketball Team Member- 2-Time KIAC Championship Winner- 2 NAIA D-II National Appearances - 4-Year Letter Winner at Baldwin High School
•Levi Masua- Seton-La Salle High School Basketball standout- 2014 Hoops for a Cure MVP- 2013-14 WPIAL championship- 2013-14 PIAA Finalist- 2013-14 undefeated section championship- 2012-13 undefeated section championship - Future Pitt-Johnstown Mountain Cat
•Gabe McNeal- Former player at Point Park University- Led KIAC & team in scoring- Ranked 11th in the nation in scoring- 19th player in Point Park history with 1,000 or more points
•Raegan Moore- Duquesne University Women’s Basketball Team Member- 4-year letter winner at Girard High School- 2-time Second Team All-PIAA selection- Region 2 Player of the Year- District 10 “Fab Five” Selection- 2-Time First Team (sophomore & junior)- 2nd Team All-Region selection (freshman) - Freshman Player of the Year for Western Pennsylvania- Swin Cash Award recipient
•Belma Nurkic- Duquesne University Women’s Basketball Team Member- Ranked 122nd best guard by ESPN HoopGurlz- Baldwin High School Basketball standout- 2010 WPIAL championship & PIAA quarterfinals- PIAA 1st Team AAAA All-State selection - Pittsburgh Post-Gazette Player of the Year and Fab 5 selection - Pittsburgh Tribune-Review Terrific 10 selection - MSA Sports Network Player of the Year
•Nikki Presto- Former head coach at Keystone Oaks High School, 2011-14- WPIAL semifinals & PIAA playoffs, 2011-12- AAA playoffs in 2011-12 and 2012-13- 4-year starter at Slippery Rock University- Top 10 in Slippery Rock history in assists and FG percentage- 3-time PSAC scholar athlete- Thomas Jefferson High School Basketball standout- 2-time AAA section champion- 1,000-point scorer- All-time leader in career assists and 3-pointers- All WPIAL 1st Team selection as senior
All camps open to ages 10-15 with separate divisions for boys & girls.
Camps meet daily 10:00 a.m.-3:00 p.m. on outdoor courts with lunch break at 12:00 noon (campers
should bring their own lunch).North Park – August 4-6Boyce Park – August 7-9
South Park – August 11-13Camp fee of $40 includes T-shirt & daily pool pass.
For more info, call 412-350-2455 or email [email protected]
Registration starts June 23 at the Boyce, North and South park offices and County Office Building.
Activities, Skills & Drills• Stretching & Warm-Ups• Stationary Ball Handling
• Moving Ball Handling• Form Shooting
• Foot Speed Drills• Passing
• Defensive Stance/Slides• Foul Shots
• Daily Competitions• Speaker of the Day
Space is limited. Sign up early!
learn fundamentals, improve skills, run through drills and have fun
Learn fundamentals, improve skills, run through drills and have fun with local coaches and players
with experience in the NBA, NCAA & WPIAL
